What ACOs say: We are saving Medicare money

WHAT ACOs SAY: WE ARE SAVING MEDICARE MONEY — A new report commissioned by the National Association of ACOs disputes CMS’ conclusions that Medicare ACOs underperformed in their first few years. Expect the findings to become fodder in a fight over a CMS proposed rule that would force certain organizations to take on financial risk faster, POLITICO’s Rachel Roubein reports.

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The ACOs argue that the Medicare Shared Savings Program produced more than $1.8 billion in gross savings between 2013 and 2015,nearly double CMS’ estimates.

The ACOs also say that CMS netted $542 million in Medicare savings (after factoring in bonuses paid to ACOs). Meanwhile, CMS data shows ACOs increased Medicare spending by about $344 million during this timeframe.

Why the report matters: It’s the latest chapter in a long-simmering fight over how ACO spending is calculated. Some researchers contend CMS’ numbers are skewed because they don'taccount for what provider spending would have been without ACOs. The fight intensified when CMS in August proposed dramatically re-shaping the ACO program, with Administrator Seema Verma suggesting that many participants aren’t helping Medicare cut costs.

** A message from PhRMA: There are wrong and right prescriptions for changing Medicare. Seniors need Washington to focus on the right ones. Cutting costs for everyone except seniors and limiting access to lifesaving medicines are the wrong prescription for Medicare. Making changes that help seniors pay less out-of-pocket are the right prescription for Medicare **

MARK YOUR CALENDARS: NEW UNINSURED, POVERTY DATA IS IMMINENT — The Census Bureau this morning will begin briefing researchers and reporters, under embargo, on findings from its annual American Community Survey.

Census officials will then announce key findings on Wednesday morning and formally release the report at 12:01 a.m. on Thursday. Along with the CDC’s National Health Interview Survey, the Census’ ACS is seen as the gold standard in tracking health insurance coverage.

— What to expect: After years of steady improvement in coverage rates under the Obama administration, the upcoming Census data is “expected to show an end to — and possibly a reversal of — these positive coverage trends,” Center on Budget and Policy Priorities researchers wrote in a preview last week.

A stall in coverage expansion may reflect that the gains linked to the Affordable Care Act have slowed down, partly because many still-uninsured U.S. residents (like millions of undocumented immigrants) are populations that are uniquely difficult to reach. But the expected findings also will likely renew concerns about the Trump administration’s efforts to unwind the ACA, a growing focus of campaign ads ahead of November’s midterms.

THIS IS TUESDAY PULSE — Where your author is headed this morning to the DMV for his long-delayed driver's test. Send tips — really, all kinds of tips, like your parallel-parking secrets — to ddiamond@politico.com. Meanwhile, send items for Wednesday PULSE to Adam Cancryn at acancryn@politico.com. (Your regular scribe returns on Thursday, hopefully with a driver's license in tow.)

INSIDE THE HUMPHREY BUILDING

HHS hosting session on how to report on suicide. The health agency at 11 a.m. this morning will convene a discussion on the best ways for media and others to discuss suicide and encourage help-seeking behaviors, as part of National Suicide Prevention month and week.

Among the scheduled speakers are Colleen Carr of the National Action Alliance for Suicide Prevention, John Draper of the National Suicide Prevention Lifeline and CNN’s Kirsten Powers. Watch livestream.

— The issue: CMS is proposing to simplify what it pays doctors for office visits, moving away from tiered payments based on a patient’s level of illness and toward flat fees.

That’s not sitting well with physician groups, which have applauded CMS' goal to reduce paperwork but warn the proposal will force them to de-prioritize more complex patients.

“This provision in the proposed rule should be filed under the category of unintended consequence – or good intentions that go awry,” AMA president Barbara McAneny said in a statement.

AROUND TOWN

California: Jerry Brown signs, vetoes more health bills. The governor on Monday signed into law Assembly Bill 2760, which requires providers who care for patients at high risk of opioid overdose – such as those with a history of substance abuse – to also provide the patients with a prescription for naloxone, the overdose antidote.

Brown also signed Senate Bill 1034, which extends California’s 2013 law that requires health providers to notify women who have dense breast tissue – a law that was set to expire next year – until 2025. About 40 percent of women have dense breasts, which makes it difficult for mammography to detect cancer.

What Brown vetoed: AB 2275, which would have required the state to set up a quality assessment and improvement program for Medicaid managed care plans. Health advocates argued the bill would improve quality and equity for patients, but the governor determined it would duplicate efforts and add costs to Medi-Cal. Read Brown’s veto message here.

NAMES IN THE NEWS

Alanna Temme joins Celgene’s public policy team. Temme, who previously worked in senior government relations roles at EMD Serono, Boehringer Ingelheim Pharmaceuticals and other policy shops, will lead Celgene’s federal government relations team as executive director. Temme also worked on the Hill and staffed the House Committee on Education and Workforce when it was chaired by then-Ohio Rep. John Boehner.

WHAT WE'RE READING

The American Hospital Association has launched a health innovation center, seeking to help systems navigate a turbulent industry, Mike Miliard writes at Healthcare IT News. More.

An ad campaign has thrust health care into the Minnesota governor's race, with candidates trading accusations about threats to patient access, J. Patrick Coolican writes in the Star Tribune. More.

Speaking of health care in the campaign season: WaPo's Paul Waldman takes a closer look at a striking ad from Joe Manchin, where the West Virginia shoots at a lawsuit attempting to roll back the ACA's protections. More.

A venture capital firm is giving 1 percent on top of every check it writes so startup founders can get access to mental health and coaching, Forbes' Alex Konrad reports. More.

A rural North Carolina hospital is steering patients to its Walmart-based clinic to take pressure off its emergency department, Taylor Knopf writes at North Carolina Health News. More.

** A message from PhRMA: There are wrong and right prescriptions for changing Medicare. Seniors need Washington to focus on the right ones. There’s a lot of talk in Washington about changing Medicare to reduce costs. But while many proposals would cut costs for governments and insurers, they won’t cut costs for seniors; and even worse, they would limit access to the medicines that could save their lives – now and in the future. Cutting costs for everyone except seniors and limiting access to medicines are the wrong prescription for Medicare. On the other hand, making changes that help seniors pay less out-of-pocket are the right prescription for Medicare **

About The Author : Dan Diamond

Dan Diamond is the author of "POLITICO Pulse," the must-read morning briefing on health care politics and policy. He's also the creator of PULSE CHECK, the popular podcast that features weekly conversations with politicians like Sen. Susan Collins, leaders like Kaiser Permanente’s Bernard J. Tyson and thinkers like Atul Gawande.

Along with his partner Rachana Pradhan, Diamond’s high-impact reporting resulted in the resignation of HHS Secretary Tom Price. Diamond also has done prize-winning reporting on hospitals’ community obligations and deep investigations into the Trump administration’s health care strategy, including its approach to vulnerable populations.

Before joining POLITICO, Diamond served as the Advisory Board Company’s senior director of news and communications. He also covered health care policy, business, and strategy for FORBES. His work has appeared at Vox, Kaiser Health News and other publications.

Diamond is a graduate of the University of Pennsylvania and has appeared to discuss health care, politics, and policy on NPR's "All Things Considered" and "Fresh Air," the NBC Nightly News, the BBC, CBS, CNN, MSNBC, the Dan Patrick Show, and other programs. Diamond has been a Yale University Poynter fellow and a fellow of the Association of Health Care Journalists.